Background New insights into the management of musculoskeletal conditions are reflected in numerous guidelines and recommendations. To bridge the gap between evidence based guidelines and clinical practice and to improve and equalize the quality of care one task for the EUMUSC.NET project (www.eumusc.net) is to develop health care quality indicators (HCQIs) to monitor the structures, processes and outcomes of health care for musculoskeletal conditions in European countries.
Objectives To make an inventory of the quality and content of currently available sets of HCQIs for Rheumatoid Arthritis (RA) and Osteoarthritis (OA).
Methods A systematic review on HCQIs for the management of RA and/or OA was performed using the following criteria: the document included the development and/or a description of one or more sets of HCQIs for the management of patients with RA and/or OA and was written in English. The search included the PubMed, EMBASE, Web of Science, Cochrane and CINAHL databases up to December 1st, 2010 and official websites of arthritis organizations of English speaking countries worldwide. The following data were extracted from the selected documents: a. general characteristics (year of publication, country, target condition, number and nature (structure, process, outcome) of HCQIs); b.quality (definition of target group, involvement of stakeholders, inclusion of patients’ view, rigor of development and scientific validity) and c. content (subject of the HCQI).
Results The search yielded 498 potentially eligible references and two websites. 463 references were excluded after screening the titles. Thirty-one of the remaining 37 documents were excluded, so that ultimately 6 original HCQI sets for RA and/or OA remained. Two sets were from European countries, 3 sets were from United States, and 1 set was Australian. The number of HCQIs ranged from 7 to 27 per set, with the majority being process indicators. With respect to the quality, the target group was defined in 5/6 HCQI sets, in 3/6 HCQI sets more than one profession was involved in the development, 4/6 HCQI sets were developed by a modified evidence- and consensus based method and in 4/6 the content validity was evaluated. Patients’ preferences were not included in any of the HCQI sets. All indicator sets for OA contained HCQIs for assessments (pain, function), and exercise while the most common subjects for the HCQIs for RA regarded assessment of disease activity and function, and management of pharmacotherapy. One of the HCQI sets for OA was dedicated to physical therapy and one of the RA-sets was exclusively for disease course monitoring.
Conclusions Currently, a limited number of sets of HCQI sets for the management of OA and RA is available, mainly including process indicators. The developmental process was methodologically flawed in all cases. As improvement of health care is an ongoing process there is a need for the development of HCQIs covering all aspects of health care quality (structure, process and outcome), using appropriate methodology, and considered relevant and applicable in all countries.
Disclosure of Interest None Declared
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